In a NEJM Catalyst analysis, Joseph C. Kvedar, MD, and Alexander L. Fogel argue the rise of digital health is hampered by products that do well in clinical trials, but fall short in real-world settings.

Digital health tools — which frequently aim to intervene in patient health via behavioral changes — necessitate high levels of engagement. In clinical trials, researchers might use monitoring or incentives to encourage patients to use a product appropriately. However, in the real world, patients will not experience this same "artificial scenario."

To address this issue, the writers suggest researchers use real-world data and evidence, alongside their clinical trials, to ensure the product can be scaled effectively. After validation, the writers also suggest product developers draw from behavioral economics, "using sophisticated implementations of financial incentives, loyalty points, social structures and other techniques" to increase patient engagement.

"While 'gamification,' as this approach is known, has been mostly met with a tepid response from the physician community, don't forget that Pokémon GO has performed better than many digital health tools at increasing the physical activity levels of its users," they write.